1
|
Rooney C, Pyer M, Campbell J. Leaving it at the gate: A phenomenological exploration of resilience in mental health nursing staff in a high-secure personality disorder unit. J Adv Nurs 2024; 80:2880-2892. [PMID: 37975293 DOI: 10.1111/jan.15947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 10/26/2023] [Accepted: 10/28/2023] [Indexed: 11/19/2023]
Abstract
AIMS AND DESIGN This study reports a qualitative phenomenological investigation of resilience in nursing staff working in a high-secure personality disorder service. METHOD Interviews were carried out with six nursing staff, and these captured the richness and complexity of the lived experience of nursing staff. RESULTS Four superordinate themes emerged from the analysis: Management of emotions: participants showed an awareness that their job is about giving care to patients who may present with very challenging behaviours. The care that they offered was conceptualized as something that needed to be provided in a measured way, with boundaries. A clear distinction was drawn between 'caring personally' for patients, and 'providing care'. Teamwork: teamwork was cited as a major influencing factor by all participants. This was seen as directly impacting the smooth running of the ward, and therefore on the well-being of nursing staff, but also of patients. Understanding: nursing staff were acutely aware that they were working in an environment where everyday interactions would be open to intense scrutiny and possible misinterpretation by patients. Work-life balance: All the participants spoke of making a conscious effort to have a separate work and home life, which was influenced by a number of factors. CONCLUSION The article has discussed the themes of managing emotion, team understanding and work-life balance, illustrating how each contributes to the resilience of nursing staff in this challenging environment. New insights - applicable in both national and international contexts - have been produced. IMPACT In secure environments, mental health nursing staff need organizational support and assistance to develop ways of managing difficult experiences with patients, systems that promote recovery, and educational and supervisory support to help understand and process the effects on them. This article provides evidence to support the work of managers and clinicians in these environments. No Patient or Public Contribution.
Collapse
Affiliation(s)
- Carol Rooney
- Niche Health & Social Care Consulting, Trafford House, Manchester, UK
| | - Michelle Pyer
- Faculty of Health, Education and Society, University of Northampton, University Drive, Northampton, UK
| | - Jackie Campbell
- Faculty of Health, Education and Society, University of Northampton, University Drive, Northampton, UK
| |
Collapse
|
2
|
Deiber MP, Piguet C, Berchio C, Michel CM, Perroud N, Ros T. Resting-State EEG Microstates and Power Spectrum in Borderline Personality Disorder: A High-Density EEG Study. Brain Topogr 2024; 37:397-409. [PMID: 37776472 PMCID: PMC11026215 DOI: 10.1007/s10548-023-01005-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 08/30/2023] [Indexed: 10/02/2023]
Abstract
Borderline personality disorder (BPD) is a debilitating psychiatric condition characterized by emotional dysregulation, unstable sense of self, and impulsive, potentially self-harming behavior. In order to provide new neurophysiological insights on BPD, we complemented resting-state EEG frequency spectrum analysis with EEG microstates (MS) analysis to capture the spatiotemporal dynamics of large-scale neural networks. High-density EEG was recorded at rest in 16 BPD patients and 16 age-matched neurotypical controls. The relative power spectrum and broadband MS spatiotemporal parameters were compared between groups and their inter-correlations were examined. Compared to controls, BPD patients showed similar global spectral power, but exploratory univariate analyses on single channels indicated reduced relative alpha power and enhanced relative delta power at parietal electrodes. In terms of EEG MS, BPD patients displayed similar MS topographies as controls, indicating comparable neural generators. However, the MS temporal dynamics were significantly altered in BPD patients, who demonstrated opposite prevalence of MS C (lower than controls) and MS E (higher than controls). Interestingly, MS C prevalence correlated positively with global alpha power and negatively with global delta power, while MS E did not correlate with any measures of spectral power. Taken together, these observations suggest that BPD patients exhibit a state of cortical hyperactivation, represented by decreased posterior alpha power, together with an elevated presence of MS E, consistent with symptoms of elevated arousal and/or vigilance. This is the first study to investigate resting-state MS patterns in BPD, with findings of elevated MS E and the suggestion of reduced posterior alpha power indicating a disorder-specific neurophysiological signature previously unreported in a psychiatric population.
Collapse
Affiliation(s)
- Marie-Pierre Deiber
- Department of Psychiatry, University Hospitals of Geneva, Chemin du Petit-Bel-Air 2, 1226 Thônex, Geneva, Switzerland.
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Camille Piguet
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of Pediatrics, University Hospitals of Geneva, Geneva, Switzerland
| | - Cristina Berchio
- Department of Pediatrics, University of Geneva, Geneva, Switzerland
| | - Christoph M Michel
- Functional Brain Mapping Laboratory, Department of Fundamental Neuroscience, University of Geneva, Geneva, Switzerland
- Center for Biomedical Imaging, CIBM, Lausanne, Switzerland
| | - Nader Perroud
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Psychiatric Specialties, Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Tomas Ros
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Center for Biomedical Imaging, CIBM, Lausanne, Switzerland
- Department of Neuroscience, University of Geneva, Geneva, Switzerland
| |
Collapse
|
3
|
Baker C, Fairclough S, Ogden RS, Barnes R, Tootill J. Trait impulsivity influences behavioural and physiological responses to threat in a virtual environment. Sci Rep 2024; 14:9484. [PMID: 38664505 PMCID: PMC11045749 DOI: 10.1038/s41598-024-60300-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 04/21/2024] [Indexed: 04/28/2024] Open
Abstract
Trait impulsivity represents a tendency to take action without forethought or consideration of consequences. This trait is multifaceted and can be decomposed into attentional, motor and non-planning subtypes of impulsivity. The purpose of the current study was to investigate how subtypes of trait impulsivity responded to different degrees of threat within room-scale virtual reality (VR) with respect to behaviour and level of physiological activation. Thirty-four participants were required to negotiate a virtual environment (VE) where they walked at height with the continuous threat of a virtual 'fall.' Behavioural measures related to the speed of movement, interaction frequency and risk were collected. Participants also wore ambulatory sensors to collect data from electrocardiogram (ECG) and electrodermal activity (EDA). Our results indicated that participants who scored highly on non-planning impulsivity exhibited riskier behaviour and higher skin conductance level (SCL). Participants with higher motor impulsivity interacted with more objects in the VE when threat was high, they also exhibited contradictory indicators of physiological activation. Attentional impulsivity was associated with a greater number of falls across the VE. The results demonstrate that subtypes of trait impulsivity respond to threats via different patterns of behaviour and levels of physiological activation, reinforcing the multifaceted nature of the trait.
Collapse
Affiliation(s)
- Christopher Baker
- School of Computer Science & Mathematics, Liverpool John Moores University, Liverpool, UK.
| | | | - Ruth S Ogden
- School of Psychology, Liverpool John Moores University, Liverpool, UK
| | - Rachel Barnes
- School of Psychology, Liverpool John Moores University, Liverpool, UK
| | - Jessica Tootill
- School of Psychology, Liverpool John Moores University, Liverpool, UK
| |
Collapse
|
4
|
Wimbarti S, Kairupan BHR, Tallei TE. Critical review of self-diagnosis of mental health conditions using artificial intelligence. Int J Ment Health Nurs 2024; 33:344-358. [PMID: 38345132 DOI: 10.1111/inm.13303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/26/2024] [Accepted: 01/30/2024] [Indexed: 03/10/2024]
Abstract
The advent of artificial intelligence (AI) has revolutionised various aspects of our lives, including mental health nursing. AI-driven tools and applications have provided a convenient and accessible means for individuals to assess their mental well-being within the confines of their homes. Nonetheless, the widespread trend of self-diagnosing mental health conditions through AI poses considerable risks. This review article examines the perils associated with relying on AI for self-diagnosis in mental health, highlighting the constraints and possible adverse outcomes that can arise from such practices. It delves into the ethical, psychological, and social implications, underscoring the vital role of mental health professionals, including psychologists, psychiatrists, and nursing specialists, in providing professional assistance and guidance. This article aims to highlight the importance of seeking professional assistance and guidance in addressing mental health concerns, especially in the era of AI-driven self-diagnosis.
Collapse
Affiliation(s)
- Supra Wimbarti
- Faculty of Psychology, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - B H Ralph Kairupan
- Department of Psychiatry, Faculty of Medicine, Sam Ratulangi University, Manado, North Sulawesi, Indonesia
| | - Trina Ekawati Tallei
- Department of Biology, Faculty of Mathematics and Natural Sciences, Sam Ratulangi University, Manado, North Sulawesi, Indonesia
- Department of Biology, Faculty of Medicine, Sam Ratulangi University, Manado, North Sulawesi, Indonesia
| |
Collapse
|
5
|
Roters J, Book A. Using the HEXACO to explain the structure of borderline and psychopathic personality traits. Personal Ment Health 2023; 17:352-362. [PMID: 36990660 DOI: 10.1002/pmh.1584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 03/06/2023] [Accepted: 03/18/2023] [Indexed: 03/31/2023]
Abstract
Research has examined the use of basic personality traits in describing problematic personality traits, such as borderline and psychopathic traits. Specifically, the Honesty-Humility factor of the HEXACO model of personality appears to account for a large proportion of the variance in these traits. The purpose of the present study was to examine whether the HEXACO model would similarly predict borderline traits. As found in previous research, psychopathic traits were predicted by low Honesty-Humility, Emotionality, Agreeableness, and Conscientiousness, whereas borderline traits were found to be negatively related to eXtraversion and Conscientiousness but had a significantly positive relationship with Emotionality. As Emotionality appeared to be a differential predictor in this study, future research should further examine how Emotionality distinguishes between the various problematic personality traits, which may aid potential treatments/therapies.
Collapse
Affiliation(s)
| | - Angela Book
- Brock University, St. Catharines, Ontario, Canada
| |
Collapse
|
6
|
Tobiassen AH, Sundal T, Stänicke E, Folmo EJ. The cultural change narrative as a core component of therapeutic change. Front Psychiatry 2023; 14:1149984. [PMID: 37867772 PMCID: PMC10587421 DOI: 10.3389/fpsyt.2023.1149984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 09/19/2023] [Indexed: 10/24/2023] Open
Abstract
Introduction Research indicates a similar effect of Mentalization-based treatment (MBT) and Dialectical behavior therapy (DBT) for borderline personality disorder (BPD). However, there is a paucity in studies investigating the change narrative received from and developed in these treatments. The aim of the present study is to investigate similarities and differences in the change narratives provided by MBT and DBT, and how these narratives reflect the rationale, explanations, and procedures of the provided treatment. Methods The study is a qualitative analysis of seven interviews conducted by the authors. Three of the participants had received MBT, and four of the participants had received DBT. This study presents an Interpretative Phenomenological Analysis (IPA) of the change narratives received in two specialized treatments for BPD. Results The main findings from the IPA were that the change narratives described by the participants reflected the treatment they received. The DBT participants highlighted explicit learning of tools and techniques, with predictable and safe therapists. In contrast, the MBT participants emphasized a long-lasting process of exploring to create procedural learning with therapists who followed their lead. Discussion The participants' stories of change shed light on how a change narrative was developed, and therefore how the rationale, explanations and procedures were conveyed differently by MBT and DBT.
Collapse
Affiliation(s)
| | | | - Erik Stänicke
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | | |
Collapse
|
7
|
Ansari D, Lakkimsetti M, Olaleye KT, Bhullar JVK, Shah RZ, Arisoyin AE, Nadeem H, Sacal Slovik SC, Habib FZ, Abdin ZU, Zia Ul Haq M. Genetic Influences on Outcomes of Psychotherapy in Borderline Personality Disorder: A Narrative Review of Implications for Personalized Treatment. Cureus 2023; 15:e43702. [PMID: 37724239 PMCID: PMC10505449 DOI: 10.7759/cureus.43702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 08/18/2023] [Indexed: 09/20/2023] Open
Abstract
Borderline personality disorder (BPD) manifests as instability in mood, relationships, self-image, and behavior, representing a challenging mental health issue. This review scrutinizes genetic factors influencing BPD and the corresponding treatment outcomes. The primary objective of this narrative review is to illuminate the association between genetic factors and BPD treatment outcomes, discussing the potential of genetic testing for personalized therapy. The review is derived from observational and experimental studies on BPD, genetic factors, and psychotherapy from 2000 to 2023, sourced primarily through PubMed. Reviews and meta-analyses were excluded. Our review suggests that genetic factors account for 40-60% of BPD variation, with significant roles played by epigenetic alterations like DNA methylation and microRNAs, particularly in the context of childhood trauma. Gene-environment interactions are also vital for BPD's development. Treatments such as dialectical behavior therapy, mentalization-based therapy, and schema therapy have shown efficacy, with success variability possibly linked to genetic factors. However, existing research is constrained by recall bias, diverse methodologies, and limited sample sizes. Future research necessitates long-term follow-up, diverse populations, and controlled variables to enhance our comprehension of BPD treatment outcomes' genetic foundations. The review underlines the promise of personalized medicine in BPD treatment, driven by genetic insights.
Collapse
Affiliation(s)
- Danya Ansari
- Psychiatry, Islamabad Medical and Dental College, Islamabad, PAK
| | | | | | | | - Rida Z Shah
- Psychiatry and Behavioral Sciences, Dow University of Health Sciences, Karachi, PAK
| | | | - Huzaifa Nadeem
- Psychiatry, Combined Military Hospital (CMH) Lahore Medical College, Lahore, PAK
| | | | | | - Zain U Abdin
- Medicine, District Head Quarter Hospital, Faisalabad, PAK
| | - Muhammad Zia Ul Haq
- Epidemiology and Public Health, Emory University Rollins School of Public Health, Atlanta, USA
- Noncommunicable Diseases and Mental Health, World Health Organization, Cairo, EGY
| |
Collapse
|
8
|
Safarzadeh A, Bakhtiari M, Shaeiri MR, Kheradmand A, Saberihaji M. Effectiveness of dialectic-behavioral skills training based on Soler model alone and along with family education in reduction of borderline personality disorder symptoms with three months follow up. NEUROLOGY, NEUROPSYCHIATRY, PSYCHOSOMATICS 2023. [DOI: 10.14412/2074-2711-2023-1-50-56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Affiliation(s)
- A. Safarzadeh
- Department of Clinical Psychology, Shahid Beheshti University of Medical Sciences
| | - M. Bakhtiari
- Department of Clinical Psychology, Shahid Beheshti University of Medical Sciences
| | | | - A. Kheradmand
- Department of Psychiatry, Shahid Beheshti University of Medical Sciences
| | - M. Saberihaji
- Department of Social Medicine, Baqiyatallah University of Medical Sciences
| |
Collapse
|
9
|
Najand B, Christensen A, Martin M, Spelman M. Sleep-deprived electroencephalography, a forgotten investigation in psychiatry; a case series. Int J Psychiatry Med 2023; 58:69-80. [PMID: 35067085 DOI: 10.1177/00912174211068361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Many patients with psychiatric disorders may have epileptic disorders; however, clinical diagnosis without imaging investigation may result in misdiagnosis and thus resistance to treatment. We investigated electroencephalography (EEG) abnormalities in the patients with psychiatric disorders referred to us with treatment resistance. METHODS In this case series study, nine patients with mood and psychotic symptoms who were referred to us at Belmont Private Hospital, Australia, from August 2018 to July 2020, were evaluated. RESULTS Complete examination showed the presence of undiagnosed temporal lobe epilepsy. Notably, the seizure symptoms had been assumed as part of other psychiatric co-morbidities. CONCLUSIONS This study suggests the necessity of paying attention to the biological etiologies of mental illnesses in the initial assessments in psychiatric and neurological practice. Performing electroencephalogram and treating such patients with mood stabilizers, which have antiepileptic properties, can change the course of the mental illness decisively.
Collapse
Affiliation(s)
- Babak Najand
- Senior Psychiatrist at Vian Clinic, Tehran, Iran, Diplomate and Certified Therapist from the Academy of Cognitive Behavior Therapy (A-CBT)1974
| | - Andrew Christensen
- Consultant Psychiatrist, Chair of the Faculty of Psychotherapy of 170472RANZCP, Queensland Branch, Australia
| | - Michael Martin
- Department of Psychiatry, 95050Belmont Private Hospital, Brisbane, QLd, Australia
| | - Mark Spelman
- Medical Director of Belmont Private Hospital, Department of Psychiatry, 95050Belmont Private Hospital, Brisbane, QLd, Australia
| |
Collapse
|
10
|
Sreeram A, Cross WM, Townsin L. Anti-stigma initiatives for mental health professionals-A systematic literature review. J Psychiatr Ment Health Nurs 2022; 29:512-528. [PMID: 35500153 DOI: 10.1111/jpm.12840] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 04/26/2022] [Accepted: 04/28/2022] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Negative attitudes towards mental illness lead to the formation of stigma. Stigma prevents the recovery of people diagnosed with mental illness. There is evidence of stigmatic attitudes towards mental ill health among mental health professionals. Anti-stigma initiatives, such as education and training, may be effective in enhancing or maintaining positive attitudes towards mental illness among mental health professionals. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Education and training that is designed and delivered around a specific mental health diagnosis or condition appears an appropriate strategy that could benefit mental health professionals to develop a deeper appreciation and understanding of mental ill health and its impacts on individuals. Consumer involvement in the education and training of mental health professionals regarding the stigma of mental illness is recommended; however, this is an under-explored area of investigation. There is a weak evidence base regarding the long-term sustainability of effects from anti-stigma education and training. This should be addressed via further research in future. WHAT ARE THE IMPLICATIONS FOR PRACTICES?: Anti-stigma initiatives can support mental health professionals to develop stigma-free, recovery-oriented practices in their work. Further, such initiatives can improve the provision of evidence-based quality care for the consumers, facilitating their recovery. ABSTRACT: Introduction Despite an increasing focus on stigma, evidence shows prejudicial attitudes towards mental illness among mental health professionals still exist. It is suggested that anti-stigma initiatives can aid in enhancing the attitudes of mental health professionals. However, research on initiatives targeting stigma of mental illness among mental health professionals is limited. Aim To identify and analyse scientific literature pertaining to the effectiveness of anti-stigma initiatives regarding mental ill health among mental health professionals. Method A systematic literature review was performed using the databases MEDLINE, CINAHL, PsycINFO, PubMed, Scopus, Google Search engine and Google Scholar. The papers were limited to English language, published in peer-reviewed journals with full-text articles available and published between the years 2008 and 2020 to understand the most recent trends in the attitudes of mental health professionals including nurses. The Population, Intervention, Comparison and Outcome (PICO) strategy was used to identify papers meeting the inclusion criteria. Results A total of 439 papers were identified. However, papers not meeting the inclusion criteria were excluded from selection. Three appraisers reviewed the selected papers individually using the Joanna Briggs Institute [JBI] critical appraisal tool. Finally, eight unanimously accepted papers were included in the systematic review. Several effective anti-stigma initiatives were identified through the review, and these had positive impacts on mental health professionals' attitudes towards mental illness, for at least a short period. It was identified that contact-based interventions are relevant and effective although the involvement of consumers and caregivers in the design and delivery of interventions was not explicitly addressed in detail in studies included in the review. Education strategies tailored for specific mental illness may be more appropriate, rather than approaches that refer to mental illness in general. Conclusions This review shows the evidence of pessimistic attitudes towards mental illness persists among mental health professionals. Anti-stigma initiatives identified in the selected papers were effective in changing these attitudes. Future research should be focused on the effectiveness of contact-based interventions and understanding the longer-term effects of the interventions among homogeneous groups. Full consideration of the varying level of clinical experience and expertise in mental health should guide the development and implementation of anti-stigma initiatives in this context. Implications for practice Anti-stigma interventions can have a positive impact on mental health professionals' knowledge, attitudes and supportive caring for people diagnosed with mental illness. Such anti-stigma interventions may meaningfully support stakeholders to address the impact of negative attitudes on the physical and mental health status of people diagnosed with mental illness. With sustained leadership, effort and reinforcement, it is possible to create workplace cultures that prioritize stigma-free and recovery-oriented behaviours and practices within mental health services.
Collapse
Affiliation(s)
- Anju Sreeram
- Federation University, Berwick Campus, Melbourne, Vic., Australia
| | - Wendy M Cross
- Federation University Australia, Ballarat, Vic., Australia
| | - Louise Townsin
- Federation University, Berwick Campus, Melbourne, Vic., Australia.,Torrens University, Australia, Adelaide, SA, Australia
| |
Collapse
|
11
|
Nandan NK, Soni PK, Parsaik A, Hashmi A. “Esketamine” in Borderline Personality Disorder: A Look Beyond Suicidality. Cureus 2022; 14:e24632. [PMID: 35664413 PMCID: PMC9156400 DOI: 10.7759/cureus.24632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2022] [Indexed: 11/29/2022] Open
Abstract
Borderline personality disorder (BPD) is an extremely disabling condition that affects almost every dimension of a patient’s life. The S-enantiomer of ketamine (esketamine) was approved by the Food and Drug Administration (FDA) in 2019 in conjunction with an oral antidepressant for the management of treatment-resistant depression (TRD) in adults. Our patient is a 27-year-old female with a long-standing diagnosis of BPD and treatment-resistant major depressive disorder (MDD) who presented to a tertiary care hospital after a baleful suicide attempt. As per treatment guidelines, “esketamine” intranasal spray in conjunction with citalopram 20 mg was started in the outpatient setting at a dose of 56 mg twice weekly for four weeks, followed by 56 mg once weekly, which was further titrated to 84 mg once weekly. Two years into treatment, the patient and her mother report around 70% improvement in her depression and anxiety with around 80% improvement in her behavioral symptoms. Esketamine’s potential action on patients with BPD can be partially explained by its very well-documented effect on the glutamate receptor antagonism. Additionally, patients with stress-induced suicidal ideations (SI), which are seen in borderline patients, are better responsive to ketamine. In conclusion, we recommend a trial of intranasal esketamine in patients with BPD with treatment-resistant MDD and frequent episodes of self-harm. Treatment with esketamine could potentially reduce the number of emergency room visits for impulsive suicide attempts and help reduce the life burden of BPD and its impact on family members.
Collapse
|
12
|
The triple f**k syndrome: medicine and the systemic oppression of people born into poverty. Br J Gen Pract 2022; 72:120-121. [PMID: 35210239 PMCID: PMC8884433 DOI: 10.3399/bjgp22x718661] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
|
13
|
Kozlowska U, Nichols C, Wiatr K, Figiel M. From psychiatry to neurology: Psychedelics as prospective therapeutics for neurodegenerative disorders. J Neurochem 2021; 162:89-108. [PMID: 34519052 DOI: 10.1111/jnc.15509] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/30/2021] [Accepted: 09/05/2021] [Indexed: 12/22/2022]
Abstract
The studies of psychedelics, especially psychedelic tryptamines like psilocybin, are rapidly gaining interest in neuroscience research. Much of this interest stems from recent clinical studies demonstrating that they have a unique ability to improve the debilitating symptoms of major depressive disorder (MDD) long-term after only a single treatment. Indeed, the Food and Drug Administration (FDA) has recently designated two Phase III clinical trials studying the ability of psilocybin to treat forms of MDD with "Breakthrough Therapy" status. If successful, the use of psychedelics to treat psychiatric diseases like depression would be revolutionary. As more evidence appears in the scientific literature to support their use in psychiatry to treat MDD on and substance use disorders (SUD), recent studies with rodents revealed that their therapeutic effects might extend beyond treating MDD and SUD. For example, psychedelics may have efficacy in the treatment and prevention of brain injury and neurodegenerative diseases such as Alzheimer's Disease. Preclinical work has highlighted psychedelics' ability to induce neuroplasticity and synaptogenesis, and neural progenitor cell proliferation. Psychedelics may also act as immunomodulators by reducing levels of proinflammatory biomarkers, including IL-1β, IL-6, and tumor necrosis factor-α (TNF-α). Their exact molecular mechanisms, and induction of cellular interactions, especially between neural and glial cells, leading to therapeutic efficacy, remain to be determined. In this review, we discuss recent findings and information on how psychedelics may act therapeutically on cells within the central nervous system (CNS) during brain injuries and neurodegenerative diseases.
Collapse
Affiliation(s)
- Urszula Kozlowska
- Ludwik Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw, Poland.,Institute of Bioorganic Chemistry, Polish Academy of Sciences, Poznan, Poland
| | - Charles Nichols
- Department of Pharmacology and Experimental Therapeutics, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Kalina Wiatr
- Institute of Bioorganic Chemistry, Polish Academy of Sciences, Poznan, Poland
| | - Maciej Figiel
- Institute of Bioorganic Chemistry, Polish Academy of Sciences, Poznan, Poland
| |
Collapse
|
14
|
Lampalzer U, Tozdan S, von Franqué F, Briken P. Hypersexuality and Impulsivity in Self-Referred Men With Sexual Interest in Minors: Are They Related? Do They Change During Treatment? An Exploratory Pilot Study. Sex Med 2021; 9:100429. [PMID: 34509753 PMCID: PMC8498949 DOI: 10.1016/j.esxm.2021.100429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/24/2021] [Accepted: 07/28/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction Studies on characteristics of self-referred men with sexual interest in minors (SIM) and treatment approaches in this group of patients are still relatively rare. Aim The aim of this exploratory pilot study was to investigate hypersexuality and impulsivity as 2 dynamic risk factors that could possibly change during treatment in self-referred men with SIM. Methods Data were collected at the “Kein Täter Werden (means: not become an offender)” network site in Hamburg. Using self-report questionnaires, the extent of hypersexuality and impulsivity was analyzed with the samples’ pretreatment data via descriptive statistics and compared with nonclinical samples of other studies. The relation between hypersexuality and impulsivity was analyzed via Spearman's correlation coefficient with pretreatment data (N = 77). Intragroup analysis compared hypersexuality and impulsivity from pre- and posttreatment (n = 29). Main Outcome Measures Hypersexual Behavior Inventory and Barratt Impulsiveness Scale Version 11. Results The degree of generalized impulsivity in the SIM group was comparable to that in nonclinical samples while the degree of hypersexuality was considerably higher than in nonclinical samples. Sixty-four percent of the participants were in the range of clinically relevant hypersexuality. Impulsivity and hypersexuality were weakly positively correlated with each other. During treatment hypersexuality significantly decreased while impulsivity did not differ significantly between before beginning treatment and after (partial) completion. Conclusion Hypersexuality, but not impulsivity, was pronounced in the group of self-referred men with SIM and should be targeted in treatment. In order to improve treatment outcome regarding risk reduction in self-referred men with SIM, a focus on treatment approaches that were developed to treat hypersexuality can be expected to be effective while focusing on generalized impulsivity may be less relevant. Lampalzer U, Tozdan S, von Franqué F, et al. Hypersexuality and Impulsivity in Self-Referred Men With Sexual Interest in Minors: Are They Related? Do They Change During Treatment? An Exploratory Pilot Study. Sex Med 2021;9:100429.
Collapse
Affiliation(s)
- Ute Lampalzer
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Safiye Tozdan
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fritjof von Franqué
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peer Briken
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
15
|
Munawar K, Aqeel M, Rehna T, Shuja KH, Bakrin FS, Choudhry FR. Validity and Reliability of the Urdu Version of the McLean Screening Instrument for Borderline Personality Disorder. Front Psychol 2021; 12:533526. [PMID: 34489768 PMCID: PMC8417833 DOI: 10.3389/fpsyg.2021.533526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 07/23/2021] [Indexed: 01/10/2023] Open
Abstract
Introduction: Although the translation and the validation of the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD) are performed in various languages and samples, no study has established the validity and reliability of the Urdu version of MSI-BPD in individuals with cardiac problems. Materials and Methods: The Urdu version of the MSI-BPD was prepared through the standard back-translation method. The translation and adaption were completed in four steps: forward translation, adaption and translation, back translation and committee approach, and cross-language validation. The sample, selected through the purposive sampling method, comprised of 150 adults with cardiac problems (men = 75 and women = 75), with an age range of 23-78 years (M = 55, SD = 10.6). The Cronbach alpha reliability and factorial validity of the MSI-BPD were assessed through confirmatory factor analysis (CFA) and Pearson correlation analyses. Internal consistency and test-retest reliability (at 2 weeks' interval) were used to evaluate the reliability. Statistical analyses were performed, using SPSS (version 22) and Structural Equation Modeling (SEM) software. Results: Preliminary analysis revealed that the overall instrument had good internal consistency (Urdu MSI-BPD α = 0.79; English MSI-BPD α = 0.77) as well as test-retest correlation coefficients for 15 days (r = 0.94). Conclusions: Findings suggested that the MSI-BPD, with important limitations, can be used as an effective preliminary screening tool to measure BPD in Urdu-speaking adults with cardiac problems. Further validations should be conducted to make the translated version of the MSI-BPD an appropriate tool to screen BPD in hospitals and mental health care settings.
Collapse
Affiliation(s)
- Khadeeja Munawar
- Department of Psychology, Jeffrey Cheah School of Medicine and Health Sciences (JCSMHS), Monash University Malaysia, Subang Jaya, Malaysia
| | - Muhammad Aqeel
- Department of Psychology, Foundation University, Islamabad, Pakistan
| | - Tasnim Rehna
- Department of Applied Psychology, National University of Modern Languages, Islamabad, Pakistan
| | - Kanwar Hamza Shuja
- Department of Psychology, Capital University of Science & Technology, Islamabad, Pakistan
| | - Faizah Safina Bakrin
- School of Pharmacy, Kumpulan Perubatan Johor (KPJ) Healthcare University College, Nilai, Malaysia
| | - Fahad Riaz Choudhry
- Department of Psychology, Kulliyyah of Islamic Revealed Knowledge and Human Sciences, International Islamic University Malaysia, Selayang, Malaysia
| |
Collapse
|
16
|
Ramos-Loyo J, Juárez-García C, Llamas-Alonso LA, Angulo-Chavira AQ, Romo-Vázquez R, Vélez-Pérez H. Inhibitory control under emotional contexts in women with borderline personality disorder: An electrophysiological study. J Psychiatr Res 2021; 132:182-190. [PMID: 33132135 DOI: 10.1016/j.jpsychires.2020.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/11/2020] [Accepted: 10/12/2020] [Indexed: 01/18/2023]
Abstract
Borderline personality disorder (BPD) is characterized by emotional dysregulation and difficulties in cognitive control. Inhibitory control, meanwhile, is modulated by the presence of emotional stimuli. The objective of the present study was to examine the effects of implicit emotional contexts on response inhibition in BPD patients. Participants performed a response inhibition task (Go-NoGo) under 3 background context conditions: neutral, pleasant and unpleasant. Behavioral performance did not differed between groups. Significantly higher P3NoGo amplitudes, shorter N2 latencies and lower global connectivity were observed in the patients regardless of the emotional valence of the background images compared to controls. In addition, higher P3NoGo amplitudes were correlated with more pronounced psychopathological symptoms. Emotional contexts enhanced N2 amplitudes compared to neutral ones in both groups. Results indicate that BPD required greater neural effort to successfully perform the inhibitory task. Finally, BPD showed lower synchronization between cortical regions, which may indicate a disruption in the effective temporal coupling of distributed areas associated with emotional stimuli-processing during both response and response inhibition.
Collapse
Affiliation(s)
| | | | | | | | - Rebeca Romo-Vázquez
- Department of Computational Science, CUCEI, University of Guadalajara, Mexico
| | - Hugo Vélez-Pérez
- Department of Computational Science, CUCEI, University of Guadalajara, Mexico
| |
Collapse
|
17
|
What we know - and want to know - about Family Connections: a review from the perspective of lived experience. Curr Opin Psychol 2020; 37:44-48. [PMID: 32829003 DOI: 10.1016/j.copsyc.2020.07.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/28/2020] [Indexed: 01/24/2023]
Abstract
Family Connections is a peer-led education, skills, and support program for family members of individuals with borderline personality disorder. Extant literature on Family Connections is limited but consistent in regard to methodology and outcomes, allowing for meaningful cross-study comparison. Despite evidence across studies regarding the program's efficacy, a number of questions remain to be answered. Three possible future research directions were identified from the perspective of family members with lived experience who are also Family Connections peer leaders; examining Family Connections when led by peers, gathering qualitative data about family member's experiences of Family Connections to illuminate additional program benefits, and studying the efficacy of Family Connections for family members of those with other mental health disorders.
Collapse
|
18
|
Zajenkowska A, Barycka J, Chotkowska K. Borderline personality disorder level predicts change in depressiveness after short‐term group psychotherapy: A study in a daily psychiatric clinic. COUNSELLING & PSYCHOTHERAPY RESEARCH 2020. [DOI: 10.1002/capr.12292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
19
|
Czelusta KL, Idicula S, Laney E, Nazir S, Udoetuk S. Management of Borderline Personality Disorder. Psychiatr Ann 2020. [DOI: 10.3928/00485713-20191203-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
20
|
Husain SF, Tang TB, Yu R, Tam WW, Tran B, Quek TT, Hwang SH, Chang CW, Ho CS, Ho RC. Cortical haemodynamic response measured by functional near infrared spectroscopy during a verbal fluency task in patients with major depression and borderline personality disorder. EBioMedicine 2019; 51:102586. [PMID: 31877417 PMCID: PMC6938854 DOI: 10.1016/j.ebiom.2019.11.047] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 11/15/2019] [Accepted: 11/25/2019] [Indexed: 01/18/2023] Open
Abstract
Background Functional near infrared spectroscopy (fNIRS) provides a direct and quantitative assessment of cortical haemodynamic function during a cognitive task. This functional neuroimaging modality may be used to elucidate the pathophysiology of psychiatric disorders, and identify neurophysiological differences between co-occurring psychiatric disorders. However, fNIRS research on borderline personality disorder (BPD) has been limited. Hence, this study aimed to compare cerebral haemodynamic function in healthy controls (HC), patients with major depressive disorder (MDD) and patients with BPD. Methods fNIRS signals during a verbal fluency task designed for clinical assessment was recorded for all participants. Demographics, clinical history and symptom severity were also noted. Findings Compared to HCs (n = 31), both patient groups (MDD, n = 31; BPD, n = 31) displayed diminished haemodynamic response in the frontal, temporal and parietal cortices. Moreover, haemodynamic response in the right frontal cortex is markedly lower in patients with MDD compared to patients with BPD. Interpretation Normal cortical function in patients with BPD is disrupted, but not as extensively as in patients with MDD. These results provide further neurophysiological evidence for the distinction of patients with MDD from patients with BPD.
Collapse
Affiliation(s)
- Syeda F Husain
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore; Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tong-Boon Tang
- Centre for Intelligent Signal and Imaging Research (CISIR), University Teknologi PETRONAS, Perak, Malaysia
| | - Rongjun Yu
- Department of Psychology, Faculty of Arts and Social Science, National University of Singapore, Singapore
| | - Wilson W Tam
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Bach Tran
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States; Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam; Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Travis T Quek
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Shi-Hui Hwang
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Cheryl W Chang
- Department of Psychological Medicine, National University Health System, Singapore
| | - Cyrus S Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Roger C Ho
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore; Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| |
Collapse
|
21
|
Thomas N, Gurvich C, Kulkarni J. Borderline personality disorder, trauma, and the hypothalamus-pituitary-adrenal axis. Neuropsychiatr Dis Treat 2019; 15:2601-2612. [PMID: 31564884 PMCID: PMC6743631 DOI: 10.2147/ndt.s198804] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 08/26/2019] [Indexed: 12/14/2022] Open
Abstract
Borderline personality disorder (BPD) is a complex psychiatric illness for which treatment poses a significant challenge due to limited effective pharmacologic treatments, and under-resourced psychological interventions. BPD is one of the most stigmatized conditions in psychiatry today, but can be understood as a modifiable, neurodevelopmental disorder that arises from maladaptive responses to trauma and stress. Stress susceptibility and reactivity in BPD is thought to mediate both the development and maintenance of BPD symptomatology, with trauma exposure considered an early life risk factor of development, and acute stress moderating symptom trajectory. An altered stress response has been characterized in BPD at the structural, neural, and neurobiological level, and is believed to underlie the maladaptive behavioral and cognitive symptomatology presented in BPD. The endocrine hypothalamus-pituitary-adrenal (HPA) axis represents a key stress response system, and growing evidence suggests it is dysfunctional in the BPD patient population. This theoretical review examines BPD in the context of a neurodevelopmental stress-related disorder, providing an overview of measurements of stress with a focus on HPA-axis measurement. Potential confounding factors associated with measurement of the HPA system are discussed, including sex and sex hormones, genetic factors, and the influence of sample collection methods. HPA-axis dysfunction in BPD largely mirrors findings demonstrated in post-traumatic stress disorder and may represent a valuable neuroendocrine target for diagnostic or treatment response biomarkers, or for which novel treatments can be investigated.
Collapse
Affiliation(s)
- Natalie Thomas
- Central Clinical School , Monash Alfred Psychiatry Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Caroline Gurvich
- Central Clinical School , Monash Alfred Psychiatry Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Jayashri Kulkarni
- Central Clinical School , Monash Alfred Psychiatry Research Centre, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|